Wednesday, 30 June 2010

Further to the interesting discussions in these pages about statistics and epidemiology, here is a recent letter published in The Spectator (not available online). The correspondent goes a little further in his criticisms than I would, nevertheless, it bears repeating...

Sir,

As an engineer, scientist and mathematician, I am completely in agreement with Rod Liddle's view of statistics. I have long argued, with anyone who cares to listen (and plenty who don't), that any statistic should be completely ignored if it doesn't come with a 1,000-page manual describing exactly how it was arrived at and what it means. And that manual should be read, pored over and discussed for at least ten years.

The human race has survived and flourished for hundreds of thousands of years without statistics. We survive using superstition, lust, greed and envy. All that statistics have done is make life miserable by legitimising with dubious science the personal biases of busybodies. It tells us that we shouldn't drink, shouldn't smoke and shouldn't immunise our children with the MMR vaccine. Lie, damned lies and statistics.

Tuesday, 29 June 2010

You know, sometimes I feel a little bad about singling out Winickoff, but its just like that whack a weasel game, and his head just keeps popping up.

This being Jonathan WhenIcough Winickoff, the ambitious paediatrician who popularised 'thirdhand smoke' and is now making some truly bizarre claims about secondhand smoke. Does this guy really exist or has he been invented to make Stan Glantz look reasonable?

Whatever the case, we better get used to this rising star. Last month in Vancouver he launched no fewer than NINE new papers.

Sunday, 27 June 2010

When it comes to tobacco control, it often seems that the policy is decided first and the science is produced as an afterthought. Since the lion's shares of the anti-smoking policies we see today were planned as far back as the 1970s, it is a remarkable coincidence that scientific evidence for each of them appeared at regular and timely intervals in the intervening years. This is something that The Economist gently hinted at in a recent review of a book called Merchants of Doubt:

In most of these campaigns the dissenters have argued that the American scientific establishment is tainted with an anti-corporate liberalism and is trying to impose socialism by the back door. One does not have to agree with this view, or to think that both sides are equally culpable, to feel that the ways in which science is used to generate assent for environmental action may sometimes be as interesting as the ways in which it is mobilised for dissent.

Though the authors note as a curiosity that campaigns against secondary smoke predated evidence that it did any harm, they show no desire to explore this seemingly reversed causality.

Secondhand smoke is old news in California these days, of course. These days, if you're an anti-smoking campaigner, your policy objectives are to ban smoking in the home and in the street. These 'next logical steps' have long since been settled on by the people who really matter—ie. you and your fellow 'health professionals'. All you need is a scientific fig-leaf to help you get around the quaint objections of personal liberty and individual sovereignty, which some politicians still consider important and which even you, as a citizen of a liberal democracy, feel compelled to pay lip-service to.

Of course, there isn't any serious scientific evidence that secondhand smoke from outdoors—or from next door—has the slightest effect on the health of others. Nor will there ever be. It would defy everything we know about toxicology, chemistry and biology, not to mention common sense. It's an idea of profound lunacy.

The best of a bad bunch of pseudo-scientific arguments for outdoor smoking bans are the risible notion of people being harmed by trace levels of toxins clinging to clothes and carpets ('thirdhand smoke') and the equally risible idea of cigarette butts leaching trace levels of toxins into the ground, thereby harming...er...something.

It's not very promising, I'll grant you, but it's all there is and the lack of scientific evidence is holding things up. And so, if you're California's Tobacco-Related Disease Research Program, you wave some money in the air—the traditional mating call of the quackademic—and see who responds. Hence:

TRDRP Call for Applications

Request for Proposals for TRDRP Initiative on Thirdhand Smoke and Cigarette Butts

The Tobacco-Related Disease Research Program (TRDRP) announces a Request for Proposals (RFP) to undertake studies on Thirdhand Smoke and Cigarette Butt Waste, under a new initiative.

And, if you are sitting down...

Approximately $3.75 million is expected to be available for this RFP.

That should get a response from the scientific community in these troubled economic times, wouldn't you say?

The aim of this project is, according to the TRDRP...

...to conduct research on (1) the impact of thirdhand tobacco smoke exposure from indoor surfaces and air quality on public health, and (2) the effects of water and soil contamination by cigarette butts on organisms and humans.

This talk of 'conducting research' makes it sound as if some sort of impartial investigation into science is in the offing here. Tellingly, however, in the 15 page document which gives details about the project, the word 'science' isn't used once. The word 'policy', on the other hand, is used 14 times. That's a pretty good guide to the rest of the document.

They do, however, admit that there is no existing evidence to support either proposition.

The health effects of thirdhand smoke are poorly understood.

Virtually nothing is known about the impact of cigarette butts on contamination of air, water and soil.

Very true. That being the case, you wouldn't want to make any assumption that thirdhand smoke is dangerous, would you?

1.1 Thirdhand Smoke Exposure and Health Effects

The indoor surfaces and air quality component of this initiative is intended to help create and sustain a new research niche and infrastructure in California that is expected to shed light on several concrete aspects of the public health dangers of thirdhand smoke.

And you wouldn't want to lead the researcher towards a particular conclusion or imply that you're looking for any particular outcome. Would you?

The findings from this research may have broad implications in policy enactment in California to prevent human exposure to thirdhand smoke in homes, hotels, apartment buildings, personal vehicles, gaming casinos, and hookah bars.

It is anticipated that the research outcomes will contribute to dramatically reducing the exposure of developing and newborn infants, young children, adolescent youth, and adults to potential disease-causing toxicants produced from thirdhand smoke.

And you certainly wouldn't want to suggest that the whole project is specifically designed to meet predetermined political objectives. After all, how could you—the research hasn't even begun yet. Right?

Policy Implications

How will the scientific evidence from exposure to thirdhand smoke and cigarette butt pollution emanating from the proposed collaborative studies inform the policy makers to frame new policy in California to mitigate the public health effects?

How will these studies impact indoor air quality in buildings and vehicles to protect vulnerable populations from exposure risks? Strengths of proposed strategy for investigative plans to interface with policy makers and community advocates will be evaluated by reviewers.

... Funded investigators may be called upon to provide testimony to California legislators and to collaborate with policy researchers to help enact and enforce policies in California to mitigate the health effects of exposure to thirdhand smoke and cigarette butt pollution of water and soil in California.

It sounds a pretty sweet deal—the TRDRP provides the conclusion and the researcher fills in the blanks. All we need is someone prepared to prostitute their scientific integrity for a huge pile of cash. And let's look at all that lovely money again...

The TRDRP has allocated up to $3.75 million over three years for this RFP. It is anticipated that TRDRP may fund up to two (2) Grants of up to $425,000 each, or may fund one (1) Grant of up to $850,000 (including direct and indirect costs) per year for three (3) years to investigate the chemicals, biology and health risk assessment of thirdhand smoke.

What kind of person are we looking for anyway? A project like this would require someone highly trained in toxicology and the physical sciences, no?

A successful application will demonstrate in the Key Personnel a diverse tobacco-related disease and control expertise that is consistent with the proposed aims in the identified two or three themed areas, such as basic, translational and (if applicable) clinical expertise including chemists, biological chemists, cellular and molecular toxicologists...

Fair enough.

...engineers...

Sounds like a job for the great mechanical engineer Stanton Glantz. He's no stranger to a TRDRP handout, plus he lives locally. Get him on the phone.

Thursday, 24 June 2010

I'm currently reading Iain Gately's Drink: A Cultural History of Alcohol, an astonishingly thorough history of the world through the eyes of drinkers. In particular, my eyes were drawn to this passage regarding 13th Century England:

Ale was so vital to the very existence of the third estate that its price and quality were regulated by law. In 1267, King Henry III issued a pioneering piece of consumer protection legislation—the Assize of Bread and Ale—which set the maximum retail price of town-brewed ale at one penny for two gallons; the same penny bought three gallons from a country brewer. Prices were to be reviewed each year and could be adjusted in accordance with fluctuations in the cost of grain.

How times change, eh? Henry III would surely approve of Cooking Lager's campaign to 'Make it the Maximum'.

In a recent post, I asked why the number of 'preventable' deaths seem to add up to more than the number of actual deaths. The answer, in a nutshell, is that you can only die once but your death can be prevented many times. In the comments, Carl V. Phillips explained how it works. I repeat his comments here in case you missed them, and because I have a feeling I'll be referring to them again in the future.

While I certainly agree with you that some or all of the "blame the victim" body count estimates are high, be careful about this criticism -- it is not legitimate. Diseases and deaths always have multiple component causes, all of which can legitimately be called the cause (which is to say a necessary -- not sufficient -- cause of that death or disease at the particular time).

So an individual may well die from smoking AND obesity AND eating junk food, and it is perfectly legitimate to say that had any one of these conditions been eliminated the death would not have occurred so soon. Someone who was killed by a drunk driver because a medical error prevented him from being saved in the hospital is a death due to alcohol use, motorized transport, and medical errors, so the causes add up to 3 for the one death. Thus, there is no reason to expect they would add up to the total. Indeed, they should add up to well more than the total if you have a rich enough list of causes.

I agree that this may not be how the man on the street interprets it, though I suspect if pushed that man would not actually be able to clearly state what he thinks it means. That is one of the problems with reciting raw scientific information to people who do not understand the science. Most people do not understand a relative risk statistic, but are barraged with them. But even descriptive statistics -- which most people probably think they understand at first blush -- are subtle. Nothing causes a fraction of a death -- it either causes it or not (see below). There is no obvious way to assign fractions.

As for bringing a death forward by merely one day, that is a fundamentally different question. And, yes, you could argue that a death that is accelerated by just one day by a particular cause should not be attributed to that cause for purposes of assessing public health statistics.

Wouldn't the word "factor" be more appropriate than "cause"? No. Cause is exactly the right word. It is the right word in the science of epidemiology (which is the source of this information) and is also the right word based on the usual intuitive definition. The latter, which is technically translated in epidemiology and most other sciences, is that in the absence of the particular influence, the particular outcome would not have occurred.

The word "factor" is one of those that often gets used because someone does not want to admit that they are making causal claims, even though that is exactly what they are doing. It doe not really mean anything. E.g., the phrase "risk factor", as used, has at least three or four different very distinct meanings, and therefore is worse than useless.

Following the above, it is easy to see why everything has multiple causes. Every death was caused by not only some disease, but also by birth of the individual in question, the evolution of humanity, the big bang, etc. This is part of why assigning fractions would not make sense, as noted above.

Angry Exile said:

And if a smoker goes outside the pub for a fag in winter and as a result of the alcohol passes out and subsequently carks it of hypothermia who gets to put their statistics up by one? ASH, Alcohol Concern or the Met Office?

If the individual would not have gone outside absent his smoking habit, then, yes, smoking caused his death, as did the alcohol that caused him to pass out, the weather that caused those to result in hypothermia, as well as, perhaps, his failure to put on a coat, his companion's failure to look for him after he disappeared, cutbacks on foot patrols by the police, and any number of other things.

The summary point is very simple: Everything has an infinite multitude of causes. For a particular outcome (e.g., death) we typically identify a particular set of them as the causes we are interested in intervening on (e.g., drug use, diet, medical tech), but there is nothing magical about that list. There is no reason to expect that those causes will not overlap in many cases, and once that list is made rich enough, overlap is inevitable.

Far be it from me to argue with a professor of 'health economics' but I can see one or two problems with this...

Firstly, as I've said before, I'm quite sceptical about whether supermarkets really sell much alcohol below below cost price (ie. as a loss leader). That's mainly because I've never seen these cheap deals with my own eyes. On the other hand, I've never heard a supermarket explicitly deny doing it, and I don't know exactly what the wholesale price for a can of Heineken is, so let's assume it happens.

If it does, then surely the point is to draw people in with cheap booze and then get them to buy the core product, ie. food.

But if, as Ms. Ludbrook suggests, they sell food below cost price, that's not a loss leader, that's just making a loss. You've got nothing to lead them to.

Secondly, if you want to increase state benefits and pensions, then just campaign for that. Why go round the houses trying to making alcohol more expensive in order to (slightly) increase inflation? Besides which, food is also included in the Retail Price Index and the price of that—supposedly—is going to be "slashed".

Any anyway, people on benefits drink too, so the money you contrive to give them by increasing their benefits is going to be cancelled out by the extra money you force them to pay for their booze.

Tuesday, 22 June 2010

In light of the previous post, it is with delicious serendipity that the latest episode of Bullshit looks at the myths surrounding 'junk food'. Penn & Teller argue—nay, prove—that much of the opposition to fast food is rooted in snobbery and ignorance, as well as reminding us that 'nudging' is a euphemism for regulation and coercion.

Has any single issue campaigner ever had a more appropriate name than MeMe? I once called her a "stick-thin obsessive" (Chapter 13 of Velvet Glove, Iron Fist). She is described in rather less flattering terms here.

Today—if you're in Britain—you may well hear the latest opinions from NICE. In a nutshell, they've come up with some more nanny state policies to control what you eat, which vary from the predictable to the surreal. According the the Telegraph, their schemes include...

• Low-salt and low-fat foods should be sold more cheaply than their unhealthy counterparts, through the use of subsidies if necessary

Thereby forcing people who don't eat in a government-approved way to subsidise those who do. No thanks.

• Advertising of unhealthy foods should be banned until after 9pm and planning laws should be used to restrict the number of fast food outlets, especially near schools

Preventing businesses from opening near schools is a horrendous idea from the point of liberty, not that NICE would be interested in that. And the advertising ban won't make any difference—it didn't with alcohol—and it's impossible to define 'unhealthy' anyway, because what counts is the overall diet, not specific items in the diet. (On the other hand, if it gets the current McDonalds advert off the screens, I could be persuaded to change my mind.)

• The Common Agricultural Policy should focus more on public health, ensuring farmers are paid to produce healthier foods

What? Farmers produce fresh fruit, vegetables and meat. How are these supposed to be made healthier? It's the processing and cooking that may (or may not) make them less healthy, not the growing of them. Unless, of course, NICE want them to be grown organically, in which case they're haven't been paying attention.

• Action should also be taken to introduce a “traffic light” food labelling system, even though the European Parliament recently voted against this

Well, quite. So forget it. What is with public health campaigners thinking they can override the EU? (See minimum pricing.)

There's more of this at the Telegraphand it all follows the anti-smoking blueprint, natch. My main reason for mentioning it is not to talk about the policies themselves, but the obligatory death toll NICE have conjured up to generate the column inches.

40,000 deaths a year due to junk food, says health watchdog Nice

I've wondered for some time what would happen if you added up all the 'preventable' deaths claimed in reports like this. I've never got round to doing a proper estimate but as a very rough, back-of-the-envelope calculation, here's what I've come up with...

As a starting pointing, there are about 490,000 deaths a year in England and Wales (ONS, 2008). Of these, 175,000 involve people aged 85 or over. It's surely pushing it to describe these deaths as 'preventable', so lets exclude them, leaving a total of 315,000.

Of those 315,000, there are some that even the most eager public healthist has yet to blame on lifestyle. For example:

Intentional self-harm: 8,000

Flu/pneumonia: 11,000

Accidents (including traffic accidents): 13,00

Alzheimers/Parkinson's/motor neuron disease: 7,000

There are many, many others but let's be ultra-conservative and just exclude these 39,000 deaths. That leaves us with a total of 276,000.

Now let's look at how many deaths are attributed to specific causes in the newspapers:

In other words, we seem to have more deaths from the estimates than we have bodies in the graveyard. Even with the implicit, if ridiculous, assumption that every cancer and every heart attack is preventable, the figures don't add up (and we still haven't taken into account things like fires, assaults, drownings, murders and contagious diseases).

This, of course, is a very crude way of working it out—most of these estimates include Scotland, for one thing, and there will be some overlap between 'junk food' and 'obesity'. Nevertheless, I suspect that if a fuller analysis was carried out, we would still find that not only is every single death 'preventable', but there are not actually enough deaths to go round.

Thursday, 17 June 2010

Remember Dr Jonathan Winickoff? Early last year, he staked his claim as a rising star of quackademia by popularising the phantom menace of thirdhand smoke using nothing more than a phone survey.

Would you stop smoking if you believed that toxins clung to your clothes and killed your children? You would? Cool! In that case, thirdhand smoke exists—let's send a press release; the BBC and the Daily Mail will fall for it.

That's about the level of this guy's scientific integrity.

This utter, utter junk science was designed to further the 'next logical step' of banning smoking in the home and now, 18 months on, Winickoff has got down to brass tacks and published a call-to-arms in the New England Journal of Medicine.

As is happening with terrifying regularity these days, the whole study is beyond parody. Basically, he wants smoking banned in all public housing on the basis that deadly levels of secondhand smoke travel down air vents and through walls. This is a man for whom 'the dose makes the poison' means absolutely nothing. (But then Winickoff's a paediatrician, not a toxicologist; his two co-authors—Michelle Mello and Mark Gottlieb—are both lawyers.)

The very fact that this garbage has been published in a respected journal like the NEJM is too depressing for words, but a few things about its basic premise need to be mentioned.

A resident who smokes in a single unit within a multiunit residential building puts the residents of the other units at risk.

This is an extraordinary claim that requires extraordinary evidence. Just two references are provided to support it. One points to the Surgeon General's report Children and Secondhand Smoke Exposure. The other is a transcript of a Surgeon General's press conference on the same subject. Both encourage parents not to smoke in the home (for the sake of the children), but neither of them make any scientific claim that smokers in one apartment harm people in surrounding homes.

Tobacco smoke can move along air ducts, through cracks in the walls and floors, through elevator shafts, and along plumbing and electrical lines to affect units on other floors.

How can the NEJM print such rubbish?

Firstly, if you have a crack in the wall big enough to let in air from next door, you have bigger problems to worry about that secondhand smoke.

Secondly, air ducts don't carry air from apartment to apartment, they take air in and out of the building. Likewise the plumbing.

Thirdly, tobacco smoke coming down electrical lines? We really are in the realms of the insane now, are we not? Last month, Smokles ran a contest to find "the most ludicrous article to appear in an anti-tobacco journal in the next 6 months." I submitted the following:

Toxins from cigarettes can be transmitted down phone lines

That's got to be close enough, no? Gentlemen, I claim my five dollars.

Winickoff gives three references here: this, this and this. None of them support his claims about cracks in the walls, electrical lines or anything else.

High levels of tobacco toxins can persist in the indoor environment long after the period of active smoking — a phenomenon known as third-hand smoke.

This is bullshit of Winickoff's own making and, of course, he provides a reference to his own phone survey study as evidence (this is how 'overwhelming' evidence accumulates—see Glantz). He also refers to the Georg Matt study and twoother studies. None of these papers suggest that lingering tobacco toxins ever reach "high levels"—on the contrary, they are infinitesimally low—and none of them discuss secondhand smoke travelling between apartments.

These are the key statements upon which Winickoff hangs his case. There is not a shred of evidence for any of them. Isn't the peer-review process supposed to check these things?

Wednesday, 16 June 2010

Winston Churchill, the obese, binge-drinking chain-smoker whose life was tragically cut short at the age of 90, has had his cigar airbrushed from the photo that hangs outside the Britain at War museum.

So whodunnit? No one is owning up. Staff at the museum insist that they were unaware of the change and are not saying who handled the image.

Intriguingly the museum, which gives all profits to charity, declined to name who put together the display and, crucially, who enlarged the image for the poster.

I trust they will find out and then name and shame the person responsible. Any modification of historical documents should be treated extremely seriously by a museum of all places. This kind of airbrushing is Orwellian and Stalinist in the literal sense (although it was the Nazis who first airbrushed a photo to remove smoking—in a poster of Stalin during the Nazi-Soviet pact). None of these are precedents to be followed and, regardless of context, altering the past is a line that should never be crossed.

The Churchill airbrushing was spotted by a visitor to the museum, David McAdam, who said:

"Viewing the now disfigured image reveals just how unhinged the vociferous anti-smoking lobby has become. So much for the notion that only communist tyrants airbrushed history."

The anti-smoking lobby appears to treat history in the same casual manner as it treats science and economics. If it can be twisted to serve the overarching cause, it will. Back in 1996, an article in Tobacco Control called for an image of Franklin Roosevelt to appear sans famous cigarette-holder on the highly dubious grounds that the brain haemorrage which killed him was 'smoking-related'.

And when a US poster company airbrushed Paul McCartney's cigarette from a reproduction of the Abbey Road cover, there was no resistance from ASH. Quite the reverse.

Amanda Sandford, from anti-smoking group Ash, said: “We are happy to support this action. People who see their idols holding cigarettes are more likely to copy them and start smoking themselves.”

At the time, Simon Clark of FOREST said:

“This is pathetic. What next? We will have to remove pipes and cigars from pictures of Sherlock Holmes and Winston Churchill. These people should stop trying to re-write history."

That now looks a very prescient observation, particularly since the BBC went on to produce a Sherlock Holmes series in which the great detective never smoked a pipe. Seriously, this has got to stop.

[Dick Puddlecote has found an even older example of cigarette airbrushing.]

Monday, 14 June 2010

As expected, the English smoking ban/heart attack miracle received blanket and largely uncritical coverage last week. The study was discussed in my last post but, to briefly recap, the heart attack rate fell by 4.26% in the year after the ban came in. This was no more and no less than might be expected considering the existing downward trend (3.21% and 5.19% in the two years before). Since there had manifestly been no dramatic decline in the number of heart attacks, Anna Gilmore and her team attributed a large chunk of that 4.26% to the ban (more than half of it, in fact, hence the 2.4% figure that appeared in every news report).

This is is so speculative that it might as well be gossip. It could be true but, if it is, no statistical evidence is provided to demonstrate it. The only figures presented in the study are the crude hospital admissions data that show a continuation of the existing trend. The 2.4% figure comes out of nowhere. No workings. No calculations. No data that be verified, checked or examined. Just an assertion to be taken on trust.

We need a little more than that if we are to attribute a long-term phenomenon to a one-off event. It is as if Gilmore is doing a rain dance in the middle of a thunderstorm and demanding credit for the rain. The onus is on her to convince us that the rain would have stopped if she hadn't showed up, not the other way round. Without that, she is just another loon dancing in a downpour.

Not that any of this affected the media coverage. Few journalists seemed aware that the 2.4% figure was an estimate, or that the heart attack rate was in the midst of a long-term decline. They certainly didn't bother to ask whether the post-ban drop was any higher or lower than usual.

The Bath University research found hospital admissions for heart attacks fell 2.4 per cent in England in the year after it became the last UK nation to ban smoking in indoor public places.

The Independent, which had been an early supporter of the ban, was quick to say I-told-you-so.

The "nanny state" mostly gets a pasting from critics who dismiss government efforts to make us fitter or slimmer or healthier as unwarranted intrusion into individual's lives.

Today, the critics get their comeuppance with research showing that nannying works. In the first year after the smoking ban was introduced in July 2007, the air in bars, restaurants and offices suddenly became sweeter – and more than 1,000 heart attacks were prevented.

Still, at least they were upfront about their slippery-slope agenda:

The next targets?

* A ban on smoking in cars to protect children. Millions of children are exposed to second-hand smoke, which is worse in cars because of the confined space, says the Royal College of Physicians. Smoking is banned in cars carrying children in some states in the US, Australia and Canada.

* A minimum price for alcohol. The National Institute for Health and Clinical Excellence said it would discourage supermarkets from discounting cheap alcohol. No price was specified, but a 50 pence per unit of alcohol minimum would mean a bottle of wine would cost at least £4.50, and a pint of lager £1.14

* A fat tax, on fast foods and chocolate, to curb the obesity explosion. As smoking falls and obesity increases, experts predict the latter will come to be seen as more damaging than the former. Some want us to follow Romania's example which pledged earlier this year to introduce a tax on junk-food.

The Times, which had run an extraordinarily premature and totally inaccurate story about the study nine months earlier, won the award for the most outrageous extrapolation of the day:

Ok Pannenborg, the former chief health adviser of the World Bank, said that the British study offered compelling evidence for nations trying to tackle smoking throughout the world.

Dr Pannenborg, who is a speaker at The Times Cheltenham Science Festival, starting today, said that a basic extrapolation of the findings suggested that more than a million deaths could be averted in China if it took similar action over the next decade.

The BBC gets a fair bit of stick in the blogosphere, sometimes with good reason, but its report was actually (slightly) better than most. It did, at least, mention that...

The 2.4% drop was much more modest than that reported in some areas where similar bans have been introduced

And that...

...last year a cross-party group of MPs argued the laws needed amending to stop pubs losing valuable trade from smokers.

And, uniquely in the media last week, it allowed a critical voice to be heard:

"The number of emergency heart attack admissions had been falling for several years, even before the smoke-free legislation, so what we are seeing is part of a trend that has nothing to do with the smoking ban," said Simon Clark, director of Forest.

"This study is designed to show the benefits of prohibition. What is doesn't show is the misery that has been heaped on hundreds of thousands of people by an unnecessarily harsh and divisive piece of legislation."

It is indicative of how far reporting of these issues has sunk that I feel the need to highlight these crumbs of reason at all. Two points were rammed home in every report. (1) There had been a 2.4% fall in heart attack admissions after the smoking ban, and (2) 1,200 fewer people were admitted to hospital after the smoking ban. Both of these statements are simply untrue—the rate fell by 4.26%, or 2,300 people. This tells us something about the standard of science reporting, but it is not the real issue. The question is whether this was indicative of a smoking ban effect.

Elsewhere, Alex Massie at The Spectator and Ed West at The Telegraph wrote more sceptical articles, both linking to this blog. Dr Michael Siegel also criticised the study, with particular reference to the lack of a control group. Siegel (who is, lest we forget, an epidemiologist himself) wrote:

Readers should always be skeptical about conclusions that are not consistent with the actual data presented in a paper. When you have a graph which clearly shows no demonstrable effect of a smoking ban on heart attacks (a.k.a., a straight line), then be wary of a complex statistical analysis that shoots out a specific number.

If you can't see the effect in the graph, then it is going to be difficult to argue that any number which comes out of a computer is more believable than your own eyes. Statistical analysis is important as an adjunct to visual inspection of data, especially to help confirm visual impressions, but it is not a substitute for it.

On Massie's blog, however, the Guardian journalist Dr Ben Goldacre defended the study and complained about its critics focusing on the crude hospital admissions data.

if alex massie believes there is a problem with the variables used in the regression model, then it would be interesting and informative if he could let us know...

or maybe alex massie thinks there is something inherently flawed about the very notion of regression, or of poisson regressions in particular. if so i'd be pleased to see those views have an airing. but saying that the crude rates don't show a big change, and making a big graph of them for yourself, strikes me as being fatuous but moreover oddly uninformative.

I agree with Goldacre on many things but I think he is missing the point here. On the subject of crude rates, he may be unaware that the BMJ study is just the latest in a long line of 'heart miracle' studies, all of which—with one exception—have relied on the crude admissions data (ie. how many people were actually admitted to hospital). This method was not considered "fatuous" or "uninformative" when smoking bans supposedly "slashed" the heart attack rate in Helena, Scotland, Bowling Green and other locations. In the context of the existing scientific literature on 'heart miracles' it is therefore highly relevant to show the crude rates for England. The 'Helena hypothesis' is that heart attacks drop dramatically in absolute terms (by 40% in that instance).

Secondly, virtually every newspaper focused on the fall (the "dramatic" fall if you're the Daily Mail) in the absolute numbers. This is not surprising since the press release went well beyond "creative epidemiology" and into the realms of plain dishonesty by pitching the 2.4% estimate as if it was the absolute fall based on the crude data.

A 2.4 percent drop in the number of emergency admissions to hospital for a heart attack has been observed following the implementation of smokefree legislation in England.

What journalist could read this press release and not assume that total heart attack admissions fell by 2.4% after the smoking ban, and that there was something unusual about this? Nowhere does the press release mention the long-term trend. Nowhere does it mention that the actual "drop in the number of emergency admissions to hospital for a heart attack" was 4.26% (2,300 people), or that the 2.4% was a theoretical figure from a computer model. If the study's press release doesn't mention these facts, what chance have journalists got?

For all these reasons, it is relevant to show the crude rates. As for the use of a regression model, no one is arguing that this is not a valid statistical tool but its practical usefulness in this instance—where you have nothing to work with except aggregate data from an entire nation and no information about any of the patients—is highly questionable.

If you are studying a disease which has only a handful of possible causes, and you have solid information about the patients and the risk factors, you can estimate how many cases are caused by a single factor with a fair degree of accuracy. But heart attacks and heart disease have several hundred risk factors—not all of them are well understood and the magnitude of each of them is open to debate. Furthermore, these factors interact with one another in complex and unpredictable ways. The Gilmore study adjusted for just three of them: temperature, Christmas holidays and "week of the year". (They looked at flu seasons but seem to have dropped them from their final model). These are all perfectly reasonable variables to adjust for, but doing so does not give you a better estimate of the total cases prevented by the smoking ban, it just gives a better estimate of the total cases prevented by all the other factors combined.

On top of that, no one knows exactly why heart attack admissions have been going down at the steady rate witnessed in the last decade anyway. With a multifactoral condition, the answer is surely vastly complicated and there are many theories. Without understanding why heart attacks are declining in the first place, pinpointing and quantifying one possible risk factor for one year's decline is a fool's errand no matter how many statistical methods you use. Computer models are only as good as the data being fed into them.

None of the more convincing explanations for the long-term decline—statins, lifestyle changes, diet or even smoking prevalence—are being adjusted for in this study. Correct me if I'm wrong, but I would have thought that any one of these variables has a more substantial impact on annual AMI admissions than what day of the week Christmas happens to fall on. Note also that none of the factors adjusted for in Gilmore's study can explain the long-term decline; they fluctuate, but do not rise or fall consistently over the period (with the exception of temperature?).

More specific criticisms are impossible as none of the workings are shown. And this, really, is the crucial point. If Gilmore and company have devised a formula that successfully predicts the number of heart attacks to the nearest thousand, based on adjusting for a few minor variables, it is indeed a remarkable scientific breakthrough and we should be told more about it. But we never are. It is asserted that the smoking ban accounted for more than half of the 4.26% drop in 2007/08 but we are never shown how. This is a number that can be neither verified nor debunked. It is to be taken entirely on trust. Skirting over the details might be fair enough in a news report, but we would hope to see some actual evidence in the study itself, even if it's just the weighting of the adjustments.

Effectively, we are being told: "We know it doesn't look like the smoking ban had any effect on AMI admissions but we've run it through a computer model and it has. Trust us." Why should we? Every other smoking ban/heart attack study—whether peer-reviewed or not—has turned out to be seriously flawed. This study's findings were (erroneously) leaked to the media months in advance, the press release failed to get the most basic facts straight and no verifiable evidence is offered to support the all important 2.4% figure. Instead we have unseen adjustments based on unspoken assumptions, all carried out by the UK Centre for Tobacco Control Studies and published just in time for the government's review of the smoking ban. If this doesn't warrant a little scepticism, what does?

Wednesday, 9 June 2010

Last September, I mentioned an article in The Sunday Times which signalled that a new smoking ban/heart attack study was marching with ill-deserved confidence in our direction.

The ban on public smoking has caused a fall in heart attack rates of about 10%, a study has found.

Researchers commissioned by the Department of Health have found a far sharper fall than they had expected in the number of heart attacks in England in the year after the ban was imposed in July 2007.

This was truly remarkable news because, as regular readers of this blog and Dr Siegel's blog will know, NHS hospital admissions data clearly show that incidence of acute myocardial infarction (AMI) has continued to decline at the same rate as before the smoking ban.

This posed a problem for Dr Anna Gilmore, the ASH board member who was charged with turning this wholly unexceptional data into a new 'heart miracle'. Earlier junk studies from Scotland (Pell et al., 2008) and Helena, Montana (Sargent, Shephard & Glantz et al., 2004) had claimed a fall in heart attacks of 17% and 40% respectively. Pell did it by ignoring the NHS data set, picking an unusual time-frame and using a very idiosyncratic definition of a heart attack. Glantz did it by simply finding an unusual blip in a very small community.

But all the signs were that Gilmore would be using the full hospital admissions data record for England, which was already available online and which showed that heart attack admissions were falling by less than 5% every year before and after the smoking ban. How would she do it?

In January, I showed England's heart attack data for the second year of the smoking ban. This only confirmed the lack of any effect, and I even apologised for telling you about yet another heart miracle no-show.

The story is always the same, and I apologise for boring readers with one null study after another. But spare a thought for Dr Anna Gilmore, whose job it is to turn this mundane data into a newsworthy study showing that the smoking ban has saved thousands of lives. She may be working on it at this very moment.

The one limitation of the data used by myself and Dr Siegel was that they showed AMI admissions in the financial year (April to March). The smoking ban started on July 1 2007. We still had data for 21 months after the smoking ban, which was more than enough to show that there was no nose-dive in admissions. Still, it would have been better to have the data from July to June.

And now we do, because Anna Gilmore has published her long awaited paper in the British Medical Journal. This is what her figures show:

As expected, there are small discrepancies between the two data sets. (There tends to be slightly more admissions in the April-March set because the timeline goes further back, and Gilmore only shows one year after the ban.) But the story is the same in each—the rate of decline was the same after the ban as it was before.

If you want specifics, here are the figures Gilmore uses (table 1 of the study)...

Emergency AMI admissions in English hospitals

2002/03: 61,498

2003/04: 60,680 (a fall of 1.33%)

2004/05: 58,803 (a fall of 3.1%)

2005/06: 55,752 (a fall of 5.19%)

2006/07: 53,964 (a fall of 3.21%)

2007/08: 51,664 (a fall of 4.26%)

As you can see, the decline in admissions in the year after the smoking ban was larger than the year before but smaller than the year before that. In fact, the average in the previous two years was 4.2%—almost exactly what it was in the year after the ban (4.26%).

Faced with this evidence, from a nation of 49 million people, what else can you do but hold up your hands and admit that smoking bans have no perceivable effect on a nation's heart attack rate?

So what's Gilmore's conclusion?

We therefore conclude that the implementation of smoke-free public places is associated with significant reductions in hospital admissions for myocardial infarction

Huh?

And the accompanying press release reads:

Smokefree legislation linked to drop in admissions for heart attacks

A 2.4 percent drop in the number of emergency admissions to hospital for a heart attack has been observed following the implementation of smokefree legislation in England, researchers from the University of Bath’s Tobacco Control Research Group have found.

The legislation was introduced on 1 July 2007 and this study, funded by the Department of Health and published this week in the British Medical Journal, is the first to evaluate its impact on heart attacks.

The team, led by Dr Anna Gilmore, Director of the Tobacco Control Research Group, part of the UK Centre for Tobacco Control Studies, found there were 1200 fewer emergency hospital admissions for myocardial infarction, commonly known as heart attacks, in the year after the legislation was introduced...

Dr Gilmore said: “Given the large number of heart attacks in this country each year, even a relatively small reduction has important public health benefits. This study provides further evidence of the benefits of smokefree legislation.”

Huh?!?!!

This is a joke, right?

I'm afraid she's serious. Desperate to spin gold from straw, Gilmore throws everything she can at the data. She makes adjustments for surface air temperature, flu seasons, population size and Christmas holidays but she does not address more significant factors like smoking status, diet, exercise or stress (that's not her fault—the NHS does not have this data—but let's not pretend she is isolating smoking in public as the sole uncontrolled risk factor).

None of these calculations are shown or can be verified, but these manipulated data are then fed into a series of computer programs to arrive at an adjusted average daily admissions figure. Although Gilmore uses the July-June figures for all pre-ban years, she goes up to September 2008 for her post-ban year, thereby leaving in July and August, which is when the AMI rate is invariably at its lowest. It's baffling and more than a little suspicious. Why not go up to June 2009? Or at least stop at June 2008?

From this almost incomprehensible mass of heavily adjusted data, she arrives at the figure of 2.4% mentioned above. This 2.4% is the supposed decline in AMI admissions that she directly attributes to the smoking ban. Since the total decline was only 4.26%, this means that the smoking ban was responsible for more than half of the drop; hence the newsworthy but entirely spurious 'smoking ban prevents 1,200 heart attacks' claim.

Although the AMI rate had fallen by 3.21% and 5.19% in 2005/06 and 2006/07, we are expected to believe the decline would only have been 1.86% in 2007/08 if the smoking ban had never happened.

In short, we are expected to believe that there was going to be a smaller than average decline in AMI in 2007/08, and that the smoking ban saved the day. The fact that the decline in AMI was unexceptional in 2007/08 is therefore used as proof that the smoking ban had an exceptional effect!

This is fairy-tale science. It is sheer statistical manipulation and it is breath-taking in it scope and ambition. But then, as I have said before, it always had to be.

Tuesday, 8 June 2010

“At one level, it’s true the pharmaceutical companies are competing with the tobacco companies. But this is not Coke versus Pepsi,” Professor Glantz said. “The tobacco companies are promoting products that kill half a million people a year. The pharmaceutical companies are trying to promote health.”

Professor Glantz added: “Those are two of the world’s experts, and we need to have people in there who are not going to get snookered by the industry, falling for a bunch of phony pseudoscience."

In the forthcoming issue of Regulation (not online yet), the economist Michael Marlow looks at smoking bans from an interesting angle. Rather than looking just at revenue, he looks at compliance. Why? Because if bars are prepared to break the law despite the threat of a financial penalty, they must find it economically rewarding to do so.

Of course, hardened anti-smoking campaigners simply deny smoking bans harm the pub trade. Their insistence on a win-win from regulation sits uneasily with economists. Some pubs do benefit, of course, depending on location and clientele. Often the winners are the pubs that can offer outdoor smoking facilities, beer gardens or some protection from the elements. But these facilities alleviate the damage caused by the ban, they do not add value in themselves. Having a beer garden in January would not normally draw the punters. Only as a result of the law does such a facility suddenly become economically beneficial, and even then only at the expense of the less fortunate 'land-locked' pub down the road.

The 'adaptation' or 'evolution' of pubs—by which people mainly mean the shift towards food—also represents an attempt at limiting the damage. As Marlow says:

Deborah Arnott, chief executive of the anti-smoking group ASH, insisted it was a myth that the smoking bans in any way damaged pubs. Arnott stated: “Many pubs have shifted their focus to serving food, so they have changed their nature.” But her analysis is flawed; shifting away from alcohol and toward food reflects harm reduction efforts, and likely would have been implemented prior to the ban if they were truly profit-enhancing.

So what is the truth about compliance? This is an area that has generally received only a superficial treatment. ASH et al. tend to bandy around a 97-99% compliance rate but this is based on a self-reported survey*. More reliable figures are harder to come by, but an undercover surveillance study in 8 Scottish pubs (admittedly a very small sample) found that the law was being widely flouted in three of them, with less flagrant violations in several others.

A 2008 study by Douglas Eadie et al. of Scotland’s ban found that, despite government claims of 98 percent compliance, compliance rates from a sample of eight bars varied substantially, with the lowest levels observed in bars located in lower-income neighborhoods.

These studies never entertain the hypothesis that noncompliance indicates bans harm some businesses.

I'll come back to the Scottish study in the near future as it has some very interesting findings but, as you will know if you listened to the podcast I mentioned at the weekend, what Marlow is particularly interested in is the situation in Ohio. He's been waiting for the Ohio data for a long time and now he has it...

As you can see, there were more than 33,000 violations over two and a half years. Obviously these are just the number of times these businesses got caught—the true total can only be guessed at. With over 1,000 recorded violations every month, clearly not everybody is 'winning' from the smoking ban and, equally clearly, not everyone is happy with it.

Restaurants make up only a small number of violations. This is as you would expect, since many of them were non-smoking before the ban came in. Complaints from other customers are also more likely in restaurants than in organisations (ie. private members' clubs), which take up a disproportionately large chunk of the pie chart.

Conclusion:

Noncompliance data indicate that smoking bans impose economic harm on some bars, restaurants, and organizations, with continued noncompliance mostly in bars and organizations. Cases of continued noncompliance apparently indicate where smokers congregate and continue to smoke in the presence of the ban.

Previous studies underestimated harm to the degree that continued noncompliance indicates higher losses from greater enforcement. Public health authorities rarely publicly complain about noncompliance, since drawing attention to these owners is inconsistent with claims that bans do not cause economic harm.

On a far-from-unrelated note, Robert Prasker has recently conducted an interview with publican Nick Hogan, who talks about his experience as the first British man to be sent to prison in relation to the smoking ban. Well worth listening to—you can hear it here.

*Update: A YouGov survey is mentioned in ASH's Myths and Realities document; the link to the DoH data is broken. A later DoH document—One Year On—found 98% compliance from actual inspections. There is, however, no breakdown of which premises were visited. Does it, for example, include shops, churches, libraries etc? If anyone knows of specific for data for bars and restaurants please let me know.

Monday, 7 June 2010

A quick word about the book with the green cover advertised on the right hand side of this blog. If you're wondering what it's about and why you should read it, this article in Spiked gives a brief overview.

A ‘theory of everything’ that explains nothing

The author of The Spirit Level Delusion explains why Britain’s chattering classes were so wrong to embrace The Spirit Level and its argument that all of society’s problems are caused by inequality...

A number of bloggers have now read and reviewed the book, including the Devil's Kitchen:

As with Velvet Fist, Iron Glove, the entire volume is well-researched, very readable (I whizzed through it in one sitting) and utterly comprehensive in its demolition of The Spirit Level's data and conclusions.

...The Spirit Level's pseudo-scientific rhetoric appears to have convinced those at high level in our society—including our idiot Prime Minister—that reducing inequality is not simply a necessary evil, but an important moral crusade.

You need The Spirit Level Delusion because our leaders are in the grip of The Spirit Level's delusion.

As DK's reference to "pseudo-scientific rhetoric" suggests, part of this little green book is about the misuse of statistics for political ends (one of my favourite topics, as readers will know). Those political ends can be broadly described as anti-capitalist with strong undertones of what Daniel Ben-Ami calls 'growth scepticism'.

All of which would be of little significance had this pseudo-science not convinced a number of politicians and opinion-formers—who should really know better—that the case for bigger government is not a mere ideological preference but a scientifically proven imperative.

We are going to hear a lot more about how limiting growth and reducing inequality will make everyone happier and how we must legislate to make this happen. You need the evidence to show it is guff, you need this book.

Sunday, 6 June 2010

If you haven't already had the pleasure, there are two podcasts that are well worth listening to.

The first is Dave Goerlitz (former Winston Man and long-time anti-smoking spokesman) talking to Robert Prasker. This two part conversation covers a lot of ground, including many issues that I didn't cover in my interview with Dave last year.

The other is a very informative podcast between Professor Michael Marlow and Lawrence H. White for Econ Journal Watch, which looks at the economics of smoking bans. In particular he tells us how, as an economist, he was drawn into the area of looking at costs and benefits of smoking bans only to be told: "We already know all the answers. Everybody gains." Michael explains the fundamental reasons why this 'everybody gains' assumption defies the basic laws of economics.

Saturday, 5 June 2010

Although completely ignored by the English-speaking media, recent comments by Professor Philippe Even have been widely reported and discussed in his native France. Until recently, Philippe Even was professor emeritus at University of Paris Descartes and the president of the Research Institute Necker.

As a highly distinguished pulmonologist, he knows a thing or two about respiratory and lung diseases, which is why his comments to Le Parisien have attracted so much attention. This translation comes courtesy of the thoroughly bilingual CAGE Canada:

What do the studies on passive smoking tell us?

PHILIPPE EVEN. There are about a hundred studies on the issue. First surprise: 40% of them claim a total absence of harmful effects of passive smoking on health. The remaining 60% estimate that the cancer risk is multiplied by 0.02 for the most optimistic and by 0.15 for the more pessimistic … compared to a risk multiplied by 10 or 20 for active smoking! It is therefore negligible. Clearly, the harm is either nonexistent, or it is extremely low.

It is an indisputable scientific fact. Anti-tobacco associations report 3,000-6,000 deaths per year in France...

I am curious to know their sources. No study has ever produced such a result.

Many experts argue that passive smoking is also responsible for cardiovascular disease and other asthma attacks. Not you?

They don’t base it on any solid scientific evidence. Take the case of cardiovascular diseases: the four main causes are obesity, high cholesterol, hypertension and diabetes. To determine whether passive smoking is an aggravating factor, there should be a study on people who have none of these four symptoms. But this was never done. Regarding chronic bronchitis, although the role of active smoking is undeniable, that of passive smoking is yet to be proven. For asthma, it is indeed a contributing factor ... but not greater than pollen!

The purpose of the ban on smoking in public places, however, was to protect non-smokers. It was thus based on nothing?

Absolutely nothing! The psychosis began with the publication of a report by the IARC, International Agency for Research on Cancer, which depends on the World Health Organization. The report released in 2002 says it is now proven that passive smoking carries serious health risks, but without showing the evidence. Where are the data? What was the methodology? It's everything but a scientific approach. It was creating fear that is not based on anything.

Why would anti-tobacco organizations wave a threat that does not exist?

The anti-smoking campaigns and higher cigarette prices having failed, they had to find a new way to lower the number of smokers. By waving the threat of passive smoking, they found a tool that really works: social pressure. In good faith, non-smokers felt in danger and started to stand up against smokers. As a result, passive smoking has become a public health problem, paving the way for the Evin Law and the decree banning smoking in public places. The cause may be good, but I do not think it is good to legislate on a lie. And the worst part is that it does not work: since the entry into force of the decree, cigarette sales are rising again.

A maverick? A contrarian? Perhaps, but cui bono? The anti-smoking movement's motive for exaggerating the passive smoking threat is clear enough, but what could a retired pulmonologist have to gain from expressing his scepticism? For me, the most revealing part of the interview was his explanation for why he has waited until retiring before speaking out.

Why not speak up earlier?

As a civil servant, dean of the largest medical faculty in France, I was held to confidentiality. If I had deviated from official positions, I would have had to pay the consequences. Today, I am a free man.

Friday, 4 June 2010

Last night I spoke at the Institute of Economic Affairs in one the Voices of Freedom debates that are running from now until the end of the month (see the banner at the top of this blog).

The subject was 'which law should be repealed or amended'? I picked the Regulatory of Investigatory Powers Act. It really is a bloody awful piece of legislation. I almost felt like I was cheating by picking a law that no reasonable person could defend. Talk about low hanging fruit. Anyway, this is what I said...

I’m here to advocate the abolition of the Regulatory of Investigatory Powers Act, also known as RIPA, also known as the snoopers’ charter. You may know it as the law that allowed Dorset county council to spy on a family who wanted to send their child to their local school or as the law that allowed Cambridgeshire county council to carry out covert surveillance on paperboys suspected of working without a license. There are thousands of other such cases.

RIPA is often described as an anti-terrorism law, but that isn’t how it was sold to us when it was passed in the year 2000. This being before 9/11, the government’s excuse for this huge expansion of surveillance powers was the need to monitor those two reliable old favourites: paedophiles and drug-dealers.

In practice, that meant bugging, phone tapping, intercepting communications, directed surveillance, covert surveillance, intrusive surveillance and monitoring which websites people visit and who they e-mail. All this was to be done, said the Act, “in the interests of national security” and “for the purpose of preventing or detecting serious crime.”

RIPA was subject to almost universal media criticism in 2000, mainly because it gave the government access to e-mail, internet and telephone records. This, in itself, is probably reason enough to scrap it. What was not anticipated was the extent to which local government would exploit the legislation in the years that followed.

Post 9/11, RIPA powers were extended to virtually every branch of government, despite the fact that MI5, MI6, the police and anybody else legitimately involved in counter-terrorism already had these powers. In the name of fighting Al Qaeda, RIPA was extended to the likes of the Charity Commission, the Environment Agency, the Food Standards Agency, Ofcom, DEFRA and, as it turned out, most significantly, to every local council.

This has never really been about terrorism. What the government was saying with RIPA was that it had absolute faith that the authorities wouldn’t abuse their power, and absolutely no faith that the public would behave themselves. This unwavering confidence in the infallibility of the state combined with total mistrust of the public is the last Labour government in a microcosm. To say that RIPA has been abused is perhaps misleading. It has just been used. It is quite conceivable that Charles Clarke always intended these powers to be employed against people walking their dogs, trimming their hedges or smoking cigarettes. Whatever the original intention, that is certainly what has happened.

Last week, Big Brother Watch revealed that local authorities have used the RIPA laws 8,500 times in the last two years, including to spy on their own employees to make sure they turn up on time and are parking correctly.

Only 5% of these investigations ever resulted in a prosecution, let alone a conviction. That is an extraordinary statistic. Even with power to secretly film and follow people, they were unable to gather enough evidence to prosecute. We must presume, then, that the vast majority of the people being investigated were innocent. The whole premise of the government’s approach was wrong. By and large, the public have been behaving and by and large, the authorities have been misbehaving.

It’s time for this to stop. RIPA was an experiment in handing over the apparatus of the police state to bureaucrats, quangos and petty officials. And sure enough, it resulted in law-abiding people being put under surveillance on the whim of minor functionaries on the basis of anonymous tip offs and personal vendettas. It hasn’t worked, it was never going to work and the only thing to do now is rip up the RIPA laws and start again.

Investigating trivial criminal offences should go back to being the work of the police. Covert surveillance operations should go back to being the preserve of MI6, and any organisation that wishes to spy on people should be made to go to the same lengths as they would if they wanted to get a search warrant.

Preferably that would mean waking the home secretary up with a phone call in the middle of the night, at which point they would be told in no uncertain terms whether what they’re doing is really in the interests of national security.

This is not to argue that there is no place for video cameras in law enforcement, nor that any use of surveillance represents an Orwellian nightmare. On the other hand, just because we have the technology does not mean we should use it indiscriminately. The question is where we draw the line and I say we draw the line at RIPA, a law which could confound only the most stupid terrorist and which has instead been turned on the general population gleefully and arbitrarily by people who should never have been entrusted with such power in the first place.

About Me

Writer and researcher at the Institute of Economic Affairs. Blogging in a personal capacity.
Author of Selfishness, Greed and Capitalism (2015), The Art of Suppression (2011), The Spirit Level Delusion (2010) and Velvet Glove, Iron Fist (2009).

"Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."